Understanding Disorders of Consciousness (DoC) and How to Receive Pediatric Inpatient Care

Lindsey Nolt, SLP-CCC, CLC, and Rebecca Gormley, SLP-CCC, CBIS, CLC

Families of children who have experienced a severe brain injury face immense stress. When a child is unresponsive after such an injury, the situation can feel overwhelming. Families may not know where to turn or what to expect next.

Gaining an understanding of Disorders of Consciousness and how they are treated provides guidance, helps families make informed decisions, and supports them in navigating their child’s care and recovery journey.

What are Disorders of Consciousness?

Patients with Disorders of Consciousness (DoC) have a prolonged, altered consciousness that can be characterized by coma, vegetative state/unresponsive wakefulness syndrome or minimally conscious state based on their clinical exam after a traumatic or non-traumatic brain injury. See the keywords below for more information related to DoC:

• Coma: A state of deep unconsciousness, caused by profound neurological injury or illness. During this time, children do not wake up, open their eyes or respond to voices or touch.

• Unresponsive Wakefulness State (UWS), previously called “vegetative state:” Children may start to open their eyes and show sleep and wake times, but they are not yet aware of what’s going on around them. They might move or make sounds, but these actions are not yet purposeful.

• Minimally Conscious State (MCS): Children start to show small but clear signs of awareness. You may notice them following a voice with their eyes, trying to reach for something or reacting to familiar people or sounds. These moments show the brain is beginning to reconnect.

• Emergence from a Disorder of Consciousness: Children show consistent, purposeful actions, such as communicating, using objects or following directions. They are becoming more aware and connected with the world around them.

What are common causes of DoC?

DoC can result from traumatic brain injury (such as a car accident or fall), stroke, oxygen deprivation, infection or other neurological conditions.

How does Good Shepherd provide care for Disorders of Consciousness?

Good Shepherd Rehabilitation Hospital Pediatric Unit has special training and experience to evaluate and treat patients with severe brain injury. We pair medical management with multidisciplinary inpatient pediatric rehabilitation to give patients with DoC the best chance of recovery and emergence from minimally conscious states.

Our team delivers highly individualized treatment plans that address each patient’s unique needs. Physical, occupational, and speech/cognitive therapy occurs five or six days per week to optimize recovery while the patient also receives medical management and medication adjustments from our medical team. Treatment methods focus on promoting optimal positioning and mobility, and identifying environmental modifications that support arousal, communication and cognitive recovery.

What are admission criteria?

At Good Shepherd, we have a pre-admission process utilizing collaboration and support of acute care providers in making appropriate referrals and communication with families/support systems to receive inpatient care for DoC. Admission decisions are based on the clinical status of the person served, independent of social, psychological or demographic characteristics.

Who are the members on the DoC team?

The Disorders of Consciousness (DoC) team features caring professionals with special training and experience in helping children recover from serious brain injuries. The team includes a physiatrist (doctor specializing in physical medicine and rehabilitation), nurse practitioner, pediatric neuropsychologist, rehabilitation nurses, case manager, physical therapist, occupational therapist, speech therapist, respiratory therapist, recreational therapist and registered dietician.

Goals

Recovery after a severe brain injury involves a combination of careful medical care, therapy and family support. Our team provides ongoing medical management to maintain your loved one’s current level of function and help promote wakefulness. A team of specialists works with your loved one through physical, occupational and speech/cognitive activities designed to engage both mind and body, while continuously monitoring responses to therapy and stimulation to adjust treatment as needed.

Depending on individual needs, care may include medications, non-medication therapies, sensory stimulation and physical rehabilitation. Families and caregivers also receive training and guidance to feel confident and prepared as their loved one transitions back into the community, school or daily life. Recovery is a team effort and families play a central role every step of the way.

What to expect

Both you and your child take part in several evaluations upon admission to Good Shepherd. These assessments help the treatment team understand your child’s medical history, functional changes and equipment needs. The goal is to gather necessary information to create a personalized treatment plan that meets your child and family’s unique needs. It is important for us to understand your child’s history, current abilities, areas of need and your goals for the inpatient stay. Each member of the multidisciplinary team will complete evaluations within their area of expertise to gain a complete picture of your child’s abilities. We encourage you to be an active participant throughout this process and to provide detailed information to support the team in developing the best possible plan of care

Finding hope

Recovery can be slow and progress may be gradual, but every small improvement is meaningful. Families play a vital role in supporting recovery by staying informed, asking questions, partnering closely with their dedicated care team and remaining engaged and consistent in therapy and daily care. You are not alone on this journey. With the right support, families and patients can navigate Disorders of Consciousness with hope and resilience.

Contact us to get started or call 1-888-447-3422 (44-REHAB).